医学情景跨文化交际能力研究
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摘要
在全球化进程日益加深的今天，涉外医疗活动日趋频繁。中国医务工作者在与外籍患者进行交流和医治的过程中应具备什么样的能力，从而获得良好的医疗效果已成为医学英语教学研究中亟待重视和解决的问题。本文在跨文化交际能力理论框架下，在需求分析的基础上，尝试构建医学情景跨文化交际能力模型，并探讨对医学英语教学改革的启示。
本研究对当前涉外医疗现状，医学英语研究和教学现状进行了梳理，分析了全球一体化和文化多元化对医学专业学生所应具备的外语能力构成，目前我国医学英语的教学目标重在帮助学生掌握医学语言知识，课程设置和教材建设存在一些不合理现象，教学模式较为单一，教学效果不甚理想。学生能否得体、有效地进行医学情景交际是满足日益频繁的涉外医疗需要的关键。因此，在医学英语教学中培养学生医学情景跨文化交际能力具有很强的重要性和必要性。
本研究按照建构模型、验证模型和修正模型的逻辑结构对医学情景跨文化交际能力进行研究。首先为理论模型的建构。采用理论驱动的定性研究方法，构建以医学英语教学为目的的医学情景跨文化交际能力模型。对国内外跨文化交际能力理论、医患交际的相关论著进行研究，分析总结医患交际情景特点，文化对医患交际的影响，以及医学情景跨文化交际的难点。在对相关概念、理论进行思辨分析的基础上，以文秋芳（1999）所提出的“跨文化交际能力模型”为基础，界定了医学情景跨文化交际能力的定义和构成因素，认为医学情景跨文化交际能力是指在跨文化交际语境中，交际者得体、有效的在医学情景中实施交际行为的能力。同时定义得体为指交际行为合理、适当，符合特定文化对医学情境交际活动的预期；有效是指交际行为达到相应反馈，得到了预期的结果。它包括医学语言能力、医学情景语用能力和医学情景跨文化能力。医学语言能力是进行医学情景跨文化交际的基础，医学情景语用能力是重要的组成部分，医学情景跨文化能力是必不可少的条件。医学情景跨文化交际能力的三个组成部分是相对独立而又互相联系、互相影响、互相补充的。只有完全具备了三种能力，医学生才能在未来的涉外医疗实践中得体、有效的同外籍患者进行交流。
其次为医学情景跨文化交际能力模型正确性的验证性实证研究。本研究结合质的方法和量的方法，通过具体交际情景录音、专家访谈和调查问卷的方式收集数据，并对研究数据进行了定性分析和定量统计分析。实证研究分三部分进行：
第一部分为对真实医学情景跨文化交际录音语料的定性分析研究。研究对十六个不同医学科室的跨文化医患会话进行录音并利用转写符号进行转写，根据语料从医学英语语音、词汇和语法；医学情景英语称呼语、委婉语、礼貌用语、会话语篇结构；不同文化医学情景就医流程、用药习惯、隐私、医学决策等方面探讨了医学情景跨文化成功交际的原因、难点、障碍和冲突，认为成功进行医学情景跨文化交际应具备医学语言知识和语言技能即医学语言能力；医学情景社会语言能力、医学语篇能力和医学情景策略能力即医学情景语用能力；医学文化知识的认知、理解能力和移情能力即医学情景跨文化能力。
第二部分为医学情景跨文化交际能力访谈的研究。选取长期从事涉外医疗活动的有经验的医务人员、长期在华工作，有多次在华就医经历的外籍患者和长期从事医学英语教学的资深教师进行访谈，使医务人员和外籍患者分别从“情景需求”角度，医学英语教师从“学习需求”的角度讨论医学情景跨文化交际能力的重要性、难点以及医学情景跨文化交际能力构成。在对访谈数据进行整理和定性分析的基础上得出访谈研究的结果，认为医学情景跨文化交际由于具有特殊的不确定性，比文化内交际更加困难。它要求交际者不但要具备一定的医学语言能力，还要具备医学情景语用和文化知识以及开放、包容的心态，在交际中能够求同存异。医学情景跨文化交际能力对于医务人员顺利进行涉外医疗活动十分重要，医学语言能力是医学情景跨文化交际活动的基础条件，医学情景语用能力和跨文化能力是重要条件。
第三部分为医学情景跨文化交际能力问卷调查研究，在本文所提出的理论模型基础上，设计了医学情景跨文化交际能力问卷，对医学情景跨文化交际能力构成因素进行进一步的定量分析，以验证或修正研究模型及其假设。研究的调查对象分为两组，分别为从工作“情景需求”界定医学情景跨文化交际能力的医务人员和从学生的“学习需求”界定医学情景跨文化交际能力的高校医学英语教师。研究首先对调查本身的科学性和代表性进行了定量分析。对调查对象的个人信息进行了统计分析，结果表明调查对象具有代表性；进而对问卷的信度和代表性进行考察，结果表明问卷具有较强的信度水平和代表性。其次，对构成医学情景跨文化交际能力的各个子项目的重要性进行统计分析，以确定进行医学情景跨文化交际活动时交际者所应具备的素质，并对医务人员和高校教师两组人员对医学情景跨文化交际能力问卷子项目重要性的判断进行差异性对比，以考察从“情景需求”考虑的医务人员与从“学习需求”考虑的高校教师之间的数据有无显著性差异，研究结果是否可以用于指导医学英语教学实践。结果表明两组人员的判断无显著性差异，研究结果可以用于指导医学英语教学实践。最后对整个问卷调查子项目重要性结果进行因素分析，用定量研究的方法考察医学情景跨文化交际能力的构成因素，因素分析结果验证了医学情景跨文化交际能力由医学语言能力、医学情景语用和跨文化能力构成的结论，并归纳出医学语言能力包括医学语言知识和技能；医学情景语用能力包括医学情景社会语言能力、医学语篇能力和医学情景策略能力；医学情景跨文化能力是指医学文化知识的认知、理解能力和移情能力。
最后为理论模型的修正。在对医学情景跨文化交际录音语料研究结果、访谈结果和问卷调查研究结果进行综合分析的基础上，得出研究结论并修正本研究所构建的医学情景跨文化交际能力模型。修正后的模型认为医学情景跨文化交际能力指医务人员在医学情景中与来自其他文化的患者或家属进行得体、有效交际所需具备的医学语言能力、医学情景语用能力和医学情景跨文化能力。医学语言能力指进行医学情景跨文化交际活动所需要的医学语言知识和医学语言技能。医学情景语用能力是与医学情景语言运用适当性有关的能力。它包括医学情景社会语言能力、医学语篇能力和医学情景策略能力。医学情景跨文化能力是指医学文化知识的认知、理解能力和移情能力。三种能力是相对独立而又互相联系、互相影响、互相补充的。只有完全具备了三种能力,医学生才能在未来的涉外医疗实践中得体、有效的同外籍患者进行交流。按照修正后的理论模型，本研究提出对医学英语教学改革的启示和对未来的研究展望。
本研究是对医学情景跨文化交际能力的初步探索，形成了基本的理论框架，但还有很多问题需进一步研究。
The increasing communications in healthcare contexts are becoming more and moreimportant. It is both of significance and urgency to develop medical people’s interculturalcommunication competence in healthcare contexts (ICCHC) and reform Medical Englishteaching so as to meet the varying needs in medical situations. This study aims toinvestigate how Chinese medical staff communicates with foreign patients and what kindof competence they should develop to achieve desirable treatment effect and on this basis,an intercultural communication competence in healthcare context (ICCHC) model has beenbuilt tentatively. Being exploratory in nature, the study also suggests how to reform themedical English teaching.
The study of ICCHC is conducted in three stages: building the ICCHC model,validating the ICCHC model, and modifying the ICCHC model. Firstly, based on athorough literature review on intercultural communication competence and thecommunication in healthcare context, the author defined the ICCHC as the ability toeffectively and appropriately communicate with people from diverse cultural backgrounds,which requires medical linguistic competence, pragmatic competence in healthcarecontexts and intercultural competence in healthcare contexts. Then, an empirical study iscarried out for the purpose of validating the model in reality. The study has used qualitativeand quantitative research method to establish as complete a picture as possible of ICHCand probes its components based on the analysis of the data collected.
Finally, based on the discussion of the data, the researcher further validates andrevises the model, the general framework has been proved as complete on the whole, andthe subcategory of the components was refined. The medical linguistic competenceincludes medical linguistic knowledge and skill; the pragmatic competence in healthcarecontext includes social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context; intercultural competence inhealthcare context includes cognitive, understanding competence of medical culture andempathy. The researcher also puts forward the suggestions for medical English teachingreform and points the direction for further researches.
The thesis is composed of six chapters. They are presented as follows.
Chapter One begins with an introduction of the current situation of medical treatmentsof foreigners in China, and then the medical English researches and the situation ofmedical English teaching are presented. Therefore it is important and urgent to developintercultural communication competence in healthcare context(ICCHC) model so as tomeet the growing needs in medical situations in China.
Due to the unfamiliarity of the cultural background between doctors and patients,their communication often reduces the certainty and expectations, and may lead to doubt,misunderstanding, and even conflicts between Chinese doctor and foreign patients. Therelationship between culture, communication and healthcare has become a very complexissue which requires knowledge from various academic disciplines such as health science,sociology, psychology, bioethics, and linguistics. This complexity occurs most frequentlyin intercultural discourse where patients, their families and healthcare workers havedifferent cultural attitudes and behaviors. So it’s necessary to take into consideration thespecific health needs of these people, and improve doctor’s ability to communicatecompetently in healthcare contexts with patients from other cultures whose values,behaviors, and communications may vary from those of the doctors.
Medical English education in China’s colleges and universities is supposed to trainmedical students to meet the needs of their future career. Based on a brief review of theMedical English teaching and research, it has been found that Medical English researchmethod and scope is rather simple and narrow and that Medical English teaching fails togets its due attention in many colleges and universities. The current situations of MedicalEnglish teaching, from the curriculum, the teaching methodology, the quality of textbooksto the classroom organization, all need to be further improved.
Chapter Two consists of three parts. The first two parts are the literature review andthe third part is the construction of the ICCHC model.
The terms “communicative competence” and “intercultural communicationcompetence” are defined first. The notion of ICC is derived from “communicativecompetence”. Based on the recognition of the cultural limitations of “communicativecompetence”, the concept of “intercultural communication competence” is put forward tocomplement the concept of “communicative competence”. Spitzberg (1997) defines ICCvery broadly as an ability to communicate appropriately and effectively in a given context. Lustig and Koester(1996) views competent intercultural communication as interaction thatis perceived as effective in fulfilling certain rewarding objectives appropriate to the contextin which the interaction occurs. Chen and Starosta(1998) defines ICC as the ability toexecute communication behaviors effectively and appropriately. Although researchersdefine ICC in various ways, the author thinks that appropriateness and effectiveness arecentral to the definition of ICC competence.
Then, studies on ICC model both at home and overseas are reviewed. With the focuson its components, Byram(1997) proposes a comprehensive framework that includes threecomponents of knowledge, skills and attitudes. Kim(1992) defines the components interms of one’s “adaptive capacity”, which is comprised of cognitive (“sense-making”),affective (including emotional and aesthetic tendencies, motivational and attitudinalpredispositions), and operational/behavioral (flexible and resourceful) dimensions.Spitzberg(1997) proposes that motivation (to communicate competently), knowledge (ofhow to communicate competently), and skills (behavioral enactment of knowledge) are thekey components of ICC. According to Chen and Starosta(1998), ICC is a concept which iscomprised of cognitive, affective, and behavioral ability of interactants in the process ofintercultural communication. In China, Wen Qiufang(1999) holds that ICC includescommunicative competence and intercultural competence. In this thesis, Wen’s model isadopted.
The features on intercultural communication in healthcare contexts are also discussed.The communication in healthcare context is different from the daily communication. It’scharacterized by medical words and expressions in the discourse, the special conversationsequence, the imbalance of the doctor-patient communication, etc. As doctors and patientshave different health beliefs, it influences the belief systems of what constitutes illness,disease, health, the presentation of symptoms by patients, the decisions of physicians, andthe patient’s receptivity to recommendations. It also influences the expectations thatpatients and doctors have of each other. Thus, culture profoundly influences diagnosis,treatment, and responsiveness. However, the studies on communication between Chinesemedical staffs and foreign patients are rare, and worse still, there is little discussions onintercultural communication competence in healthcare context(ICCHC).
Based on the ICC model of Wen Qiufang, the researcher tentatively constructs theICCHC model. The model defines ICCHC as the ability to effectively and appropriatelyperform communication behaviors in healthcare context in a culturally diverseenvironment. It comprises medical linguistic competence, pragmatic competence inhealthcare context and intercultural competence in healthcare context.
Chapter Three reports an empirical study. The empirical research mainly focuses onthe four questions:(1) Does the medical linguistic competence contributes to the ICCHC?(2) Does the pragmatic competence in healthcare context contributes to the ICCHC?(3)Does the intercultural competence in healthcare context contributes to the ICCHC?(4)what’s the relationship of the three components?
The study is based on a combination of data collection methods (observations,recordings of naturally occurring medical consultations and staff meetings, interviews andquestionnaires). Communication between Chinese medical staff and foreign patients duringmedical consultations are recorded. Through the analysis of the conversation transcripts inreal healthcare situations, the researcher investigates the reasons of barriers and success ofthe communication, and tries to validate ICCHC model. Semi-structured interviews areconducted with four experienced participants of intercultural communication in healthcare(ICHC). Through the interview, the difficulties of ICHC and the experts’ idea on thedefinition and components of ICCHC are analyzed. The questionnaire on ICCHC isdistributed to two groups, the Chinese doctors and nurses who are in charge of foreignpatients’ treatment and the Medical English teachers in universities. The components of theICCHC are further discussed through the statistical analysis of the questionnaire data.
Chapter Four reports the data analysis of the recordings of naturally occurring medicalconsultations. The researcher first records the conversation between Chinese doctors,nurses and their foreign patients. And then transcribes the recording material. Theresearcher categorizes and analyzes their linguistic descriptions, the reasons, difficulties,barriers and conflicts of unsuccessful ICHC and explores in three aspects.
Firstly, it discusses that the medical English pronunciation, words and grammar maycause the difficulties, barriers and conflicts of unsuccessful ICHC.
Then, it focuses on the pragmatic aspects of the form of address, euphemism, politeusage of words and discourse structure in healthcare context, and found that it may also result in the communication breakdown.
Finally, it discusses that the culture aspects of hospitalization procedure, medicationhabits, privacy, medical decision-making in diverse medical cultures may also cause thecommunication problems.
Based on the above analysis, it’s evident that medical linguistic competence(including medical linguistic knowledge and skill); pragmatic competence in healthcarecontext (including social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context); intercultural competence inhealthcare context (including cognitive and understanding competence of medical culture,empathy competence) contribute to the successful ICHC.
Chapter Five mainly deals with the analysis of questionnaire data and interview data.The interview data is discussed first. The interview attempts to integrate the views onChinese doctor, nurse, medical English teacher and foreign patients about the ICCHCmodel and its components, and how the participants solve the problems in ICHC, Thisstudy supports the general ICCHC framework proposed in Chapter2and finds thatmedical linguistic competence is the basis for ICHC and pragmatic competence andintercultural competence in healthcare context is an important factor for ICHC.
Then to further examine the components of ICCHC, the questionnaire data iscollected from two groups of people, the doctors and nurses who define ICCHC from“situational needs” and the medical English teachers who define ICCHC from students’“study needs”. In order to examine whether the ICCHC model can be used to guide themedical English teaching or not, the researcher also uses Mann-Whitney U test to examinethe difference of the two group’s judgments on the importance of the items in thequestionnaire. The Mann-Whitney U test result shows that there are no differences betweenthe two groups of people. Finally the researcher uses factor analysis to test the importanceresult of the items of the whole questionnaire and finalized the components of ICCHC. Thefactor analysis result shows that ICCHC is composed of medical linguistic competence(including medical linguistic knowledge and skill), pragmatic competence in healthcarecontext (including social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context), intercultural competence in healthcare context (including cognitive and understanding competence of medical culture,empathy competence).
Chapter Six summarizes the research findings and presents a complete model ofICCHC. And based on the model, the author explores the pedagogical implication of theresearch findings. With the model as guidance, in the Medical English teaching reform, thefocus of Medical English teaching should fall on developing students’ interculturalcommunication competence in healthcare context in order to meet the development of thesociety and the needs of student’s future career. Also the limitations of the research arelisted, the future researches should be carried out to enlarge the quantity of the participants.
This study is a new attempt, the author endeavors to construct the ICCHC model anddiscusses the components of ICCHC, but some problems may still exist and need furtherexploration.
本研究对当前涉外医疗现状，医学英语研究和教学现状进行了梳理，分析了全球一体化和文化多元化对医学专业学生所应具备的外语能力构成，目前我国医学英语的教学目标重在帮助学生掌握医学语言知识，课程设置和教材建设存在一些不合理现象，教学模式较为单一，教学效果不甚理想。学生能否得体、有效地进行医学情景交际是满足日益频繁的涉外医疗需要的关键。因此，在医学英语教学中培养学生医学情景跨文化交际能力具有很强的重要性和必要性。
本研究按照建构模型、验证模型和修正模型的逻辑结构对医学情景跨文化交际能力进行研究。首先为理论模型的建构。采用理论驱动的定性研究方法，构建以医学英语教学为目的的医学情景跨文化交际能力模型。对国内外跨文化交际能力理论、医患交际的相关论著进行研究，分析总结医患交际情景特点，文化对医患交际的影响，以及医学情景跨文化交际的难点。在对相关概念、理论进行思辨分析的基础上，以文秋芳（1999）所提出的“跨文化交际能力模型”为基础，界定了医学情景跨文化交际能力的定义和构成因素，认为医学情景跨文化交际能力是指在跨文化交际语境中，交际者得体、有效的在医学情景中实施交际行为的能力。同时定义得体为指交际行为合理、适当，符合特定文化对医学情境交际活动的预期；有效是指交际行为达到相应反馈，得到了预期的结果。它包括医学语言能力、医学情景语用能力和医学情景跨文化能力。医学语言能力是进行医学情景跨文化交际的基础，医学情景语用能力是重要的组成部分，医学情景跨文化能力是必不可少的条件。医学情景跨文化交际能力的三个组成部分是相对独立而又互相联系、互相影响、互相补充的。只有完全具备了三种能力，医学生才能在未来的涉外医疗实践中得体、有效的同外籍患者进行交流。
其次为医学情景跨文化交际能力模型正确性的验证性实证研究。本研究结合质的方法和量的方法，通过具体交际情景录音、专家访谈和调查问卷的方式收集数据，并对研究数据进行了定性分析和定量统计分析。实证研究分三部分进行：
第一部分为对真实医学情景跨文化交际录音语料的定性分析研究。研究对十六个不同医学科室的跨文化医患会话进行录音并利用转写符号进行转写，根据语料从医学英语语音、词汇和语法；医学情景英语称呼语、委婉语、礼貌用语、会话语篇结构；不同文化医学情景就医流程、用药习惯、隐私、医学决策等方面探讨了医学情景跨文化成功交际的原因、难点、障碍和冲突，认为成功进行医学情景跨文化交际应具备医学语言知识和语言技能即医学语言能力；医学情景社会语言能力、医学语篇能力和医学情景策略能力即医学情景语用能力；医学文化知识的认知、理解能力和移情能力即医学情景跨文化能力。
第二部分为医学情景跨文化交际能力访谈的研究。选取长期从事涉外医疗活动的有经验的医务人员、长期在华工作，有多次在华就医经历的外籍患者和长期从事医学英语教学的资深教师进行访谈，使医务人员和外籍患者分别从“情景需求”角度，医学英语教师从“学习需求”的角度讨论医学情景跨文化交际能力的重要性、难点以及医学情景跨文化交际能力构成。在对访谈数据进行整理和定性分析的基础上得出访谈研究的结果，认为医学情景跨文化交际由于具有特殊的不确定性，比文化内交际更加困难。它要求交际者不但要具备一定的医学语言能力，还要具备医学情景语用和文化知识以及开放、包容的心态，在交际中能够求同存异。医学情景跨文化交际能力对于医务人员顺利进行涉外医疗活动十分重要，医学语言能力是医学情景跨文化交际活动的基础条件，医学情景语用能力和跨文化能力是重要条件。
第三部分为医学情景跨文化交际能力问卷调查研究，在本文所提出的理论模型基础上，设计了医学情景跨文化交际能力问卷，对医学情景跨文化交际能力构成因素进行进一步的定量分析，以验证或修正研究模型及其假设。研究的调查对象分为两组，分别为从工作“情景需求”界定医学情景跨文化交际能力的医务人员和从学生的“学习需求”界定医学情景跨文化交际能力的高校医学英语教师。研究首先对调查本身的科学性和代表性进行了定量分析。对调查对象的个人信息进行了统计分析，结果表明调查对象具有代表性；进而对问卷的信度和代表性进行考察，结果表明问卷具有较强的信度水平和代表性。其次，对构成医学情景跨文化交际能力的各个子项目的重要性进行统计分析，以确定进行医学情景跨文化交际活动时交际者所应具备的素质，并对医务人员和高校教师两组人员对医学情景跨文化交际能力问卷子项目重要性的判断进行差异性对比，以考察从“情景需求”考虑的医务人员与从“学习需求”考虑的高校教师之间的数据有无显著性差异，研究结果是否可以用于指导医学英语教学实践。结果表明两组人员的判断无显著性差异，研究结果可以用于指导医学英语教学实践。最后对整个问卷调查子项目重要性结果进行因素分析，用定量研究的方法考察医学情景跨文化交际能力的构成因素，因素分析结果验证了医学情景跨文化交际能力由医学语言能力、医学情景语用和跨文化能力构成的结论，并归纳出医学语言能力包括医学语言知识和技能；医学情景语用能力包括医学情景社会语言能力、医学语篇能力和医学情景策略能力；医学情景跨文化能力是指医学文化知识的认知、理解能力和移情能力。
最后为理论模型的修正。在对医学情景跨文化交际录音语料研究结果、访谈结果和问卷调查研究结果进行综合分析的基础上，得出研究结论并修正本研究所构建的医学情景跨文化交际能力模型。修正后的模型认为医学情景跨文化交际能力指医务人员在医学情景中与来自其他文化的患者或家属进行得体、有效交际所需具备的医学语言能力、医学情景语用能力和医学情景跨文化能力。医学语言能力指进行医学情景跨文化交际活动所需要的医学语言知识和医学语言技能。医学情景语用能力是与医学情景语言运用适当性有关的能力。它包括医学情景社会语言能力、医学语篇能力和医学情景策略能力。医学情景跨文化能力是指医学文化知识的认知、理解能力和移情能力。三种能力是相对独立而又互相联系、互相影响、互相补充的。只有完全具备了三种能力,医学生才能在未来的涉外医疗实践中得体、有效的同外籍患者进行交流。按照修正后的理论模型，本研究提出对医学英语教学改革的启示和对未来的研究展望。
本研究是对医学情景跨文化交际能力的初步探索，形成了基本的理论框架，但还有很多问题需进一步研究。
The increasing communications in healthcare contexts are becoming more and moreimportant. It is both of significance and urgency to develop medical people’s interculturalcommunication competence in healthcare contexts (ICCHC) and reform Medical Englishteaching so as to meet the varying needs in medical situations. This study aims toinvestigate how Chinese medical staff communicates with foreign patients and what kindof competence they should develop to achieve desirable treatment effect and on this basis,an intercultural communication competence in healthcare context (ICCHC) model has beenbuilt tentatively. Being exploratory in nature, the study also suggests how to reform themedical English teaching.
The study of ICCHC is conducted in three stages: building the ICCHC model,validating the ICCHC model, and modifying the ICCHC model. Firstly, based on athorough literature review on intercultural communication competence and thecommunication in healthcare context, the author defined the ICCHC as the ability toeffectively and appropriately communicate with people from diverse cultural backgrounds,which requires medical linguistic competence, pragmatic competence in healthcarecontexts and intercultural competence in healthcare contexts. Then, an empirical study iscarried out for the purpose of validating the model in reality. The study has used qualitativeand quantitative research method to establish as complete a picture as possible of ICHCand probes its components based on the analysis of the data collected.
Finally, based on the discussion of the data, the researcher further validates andrevises the model, the general framework has been proved as complete on the whole, andthe subcategory of the components was refined. The medical linguistic competenceincludes medical linguistic knowledge and skill; the pragmatic competence in healthcarecontext includes social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context; intercultural competence inhealthcare context includes cognitive, understanding competence of medical culture andempathy. The researcher also puts forward the suggestions for medical English teachingreform and points the direction for further researches.
The thesis is composed of six chapters. They are presented as follows.
Chapter One begins with an introduction of the current situation of medical treatmentsof foreigners in China, and then the medical English researches and the situation ofmedical English teaching are presented. Therefore it is important and urgent to developintercultural communication competence in healthcare context(ICCHC) model so as tomeet the growing needs in medical situations in China.
Due to the unfamiliarity of the cultural background between doctors and patients,their communication often reduces the certainty and expectations, and may lead to doubt,misunderstanding, and even conflicts between Chinese doctor and foreign patients. Therelationship between culture, communication and healthcare has become a very complexissue which requires knowledge from various academic disciplines such as health science,sociology, psychology, bioethics, and linguistics. This complexity occurs most frequentlyin intercultural discourse where patients, their families and healthcare workers havedifferent cultural attitudes and behaviors. So it’s necessary to take into consideration thespecific health needs of these people, and improve doctor’s ability to communicatecompetently in healthcare contexts with patients from other cultures whose values,behaviors, and communications may vary from those of the doctors.
Medical English education in China’s colleges and universities is supposed to trainmedical students to meet the needs of their future career. Based on a brief review of theMedical English teaching and research, it has been found that Medical English researchmethod and scope is rather simple and narrow and that Medical English teaching fails togets its due attention in many colleges and universities. The current situations of MedicalEnglish teaching, from the curriculum, the teaching methodology, the quality of textbooksto the classroom organization, all need to be further improved.
Chapter Two consists of three parts. The first two parts are the literature review andthe third part is the construction of the ICCHC model.
The terms “communicative competence” and “intercultural communicationcompetence” are defined first. The notion of ICC is derived from “communicativecompetence”. Based on the recognition of the cultural limitations of “communicativecompetence”, the concept of “intercultural communication competence” is put forward tocomplement the concept of “communicative competence”. Spitzberg (1997) defines ICCvery broadly as an ability to communicate appropriately and effectively in a given context. Lustig and Koester(1996) views competent intercultural communication as interaction thatis perceived as effective in fulfilling certain rewarding objectives appropriate to the contextin which the interaction occurs. Chen and Starosta(1998) defines ICC as the ability toexecute communication behaviors effectively and appropriately. Although researchersdefine ICC in various ways, the author thinks that appropriateness and effectiveness arecentral to the definition of ICC competence.
Then, studies on ICC model both at home and overseas are reviewed. With the focuson its components, Byram(1997) proposes a comprehensive framework that includes threecomponents of knowledge, skills and attitudes. Kim(1992) defines the components interms of one’s “adaptive capacity”, which is comprised of cognitive (“sense-making”),affective (including emotional and aesthetic tendencies, motivational and attitudinalpredispositions), and operational/behavioral (flexible and resourceful) dimensions.Spitzberg(1997) proposes that motivation (to communicate competently), knowledge (ofhow to communicate competently), and skills (behavioral enactment of knowledge) are thekey components of ICC. According to Chen and Starosta(1998), ICC is a concept which iscomprised of cognitive, affective, and behavioral ability of interactants in the process ofintercultural communication. In China, Wen Qiufang(1999) holds that ICC includescommunicative competence and intercultural competence. In this thesis, Wen’s model isadopted.
The features on intercultural communication in healthcare contexts are also discussed.The communication in healthcare context is different from the daily communication. It’scharacterized by medical words and expressions in the discourse, the special conversationsequence, the imbalance of the doctor-patient communication, etc. As doctors and patientshave different health beliefs, it influences the belief systems of what constitutes illness,disease, health, the presentation of symptoms by patients, the decisions of physicians, andthe patient’s receptivity to recommendations. It also influences the expectations thatpatients and doctors have of each other. Thus, culture profoundly influences diagnosis,treatment, and responsiveness. However, the studies on communication between Chinesemedical staffs and foreign patients are rare, and worse still, there is little discussions onintercultural communication competence in healthcare context(ICCHC).
Based on the ICC model of Wen Qiufang, the researcher tentatively constructs theICCHC model. The model defines ICCHC as the ability to effectively and appropriatelyperform communication behaviors in healthcare context in a culturally diverseenvironment. It comprises medical linguistic competence, pragmatic competence inhealthcare context and intercultural competence in healthcare context.
Chapter Three reports an empirical study. The empirical research mainly focuses onthe four questions:(1) Does the medical linguistic competence contributes to the ICCHC?(2) Does the pragmatic competence in healthcare context contributes to the ICCHC?(3)Does the intercultural competence in healthcare context contributes to the ICCHC?(4)what’s the relationship of the three components?
The study is based on a combination of data collection methods (observations,recordings of naturally occurring medical consultations and staff meetings, interviews andquestionnaires). Communication between Chinese medical staff and foreign patients duringmedical consultations are recorded. Through the analysis of the conversation transcripts inreal healthcare situations, the researcher investigates the reasons of barriers and success ofthe communication, and tries to validate ICCHC model. Semi-structured interviews areconducted with four experienced participants of intercultural communication in healthcare(ICHC). Through the interview, the difficulties of ICHC and the experts’ idea on thedefinition and components of ICCHC are analyzed. The questionnaire on ICCHC isdistributed to two groups, the Chinese doctors and nurses who are in charge of foreignpatients’ treatment and the Medical English teachers in universities. The components of theICCHC are further discussed through the statistical analysis of the questionnaire data.
Chapter Four reports the data analysis of the recordings of naturally occurring medicalconsultations. The researcher first records the conversation between Chinese doctors,nurses and their foreign patients. And then transcribes the recording material. Theresearcher categorizes and analyzes their linguistic descriptions, the reasons, difficulties,barriers and conflicts of unsuccessful ICHC and explores in three aspects.
Firstly, it discusses that the medical English pronunciation, words and grammar maycause the difficulties, barriers and conflicts of unsuccessful ICHC.
Then, it focuses on the pragmatic aspects of the form of address, euphemism, politeusage of words and discourse structure in healthcare context, and found that it may also result in the communication breakdown.
Finally, it discusses that the culture aspects of hospitalization procedure, medicationhabits, privacy, medical decision-making in diverse medical cultures may also cause thecommunication problems.
Based on the above analysis, it’s evident that medical linguistic competence(including medical linguistic knowledge and skill); pragmatic competence in healthcarecontext (including social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context); intercultural competence inhealthcare context (including cognitive and understanding competence of medical culture,empathy competence) contribute to the successful ICHC.
Chapter Five mainly deals with the analysis of questionnaire data and interview data.The interview data is discussed first. The interview attempts to integrate the views onChinese doctor, nurse, medical English teacher and foreign patients about the ICCHCmodel and its components, and how the participants solve the problems in ICHC, Thisstudy supports the general ICCHC framework proposed in Chapter2and finds thatmedical linguistic competence is the basis for ICHC and pragmatic competence andintercultural competence in healthcare context is an important factor for ICHC.
Then to further examine the components of ICCHC, the questionnaire data iscollected from two groups of people, the doctors and nurses who define ICCHC from“situational needs” and the medical English teachers who define ICCHC from students’“study needs”. In order to examine whether the ICCHC model can be used to guide themedical English teaching or not, the researcher also uses Mann-Whitney U test to examinethe difference of the two group’s judgments on the importance of the items in thequestionnaire. The Mann-Whitney U test result shows that there are no differences betweenthe two groups of people. Finally the researcher uses factor analysis to test the importanceresult of the items of the whole questionnaire and finalized the components of ICCHC. Thefactor analysis result shows that ICCHC is composed of medical linguistic competence(including medical linguistic knowledge and skill), pragmatic competence in healthcarecontext (including social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context), intercultural competence in healthcare context (including cognitive and understanding competence of medical culture,empathy competence).
Chapter Six summarizes the research findings and presents a complete model ofICCHC. And based on the model, the author explores the pedagogical implication of theresearch findings. With the model as guidance, in the Medical English teaching reform, thefocus of Medical English teaching should fall on developing students’ interculturalcommunication competence in healthcare context in order to meet the development of thesociety and the needs of student’s future career. Also the limitations of the research arelisted, the future researches should be carried out to enlarge the quantity of the participants.
This study is a new attempt, the author endeavors to construct the ICCHC model anddiscusses the components of ICCHC, but some problems may still exist and need furtherexploration.
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